Tele-Audiology, A Threat Or An Opportunity?

Tele-audiology, a disruptive technology that could be a threat or an opportunity

I have talked about tele-audiology before in general terms. Tele-audiology really covers the use of remote audiology through a full suite of hardware and software in the clinic location. However there is another form that most of us would be familiar with. That is the concept as it applies to a certain manufacturer’s instruments.

Basically some fine tuning can be undertaken via the telephone, this manufacturer has also moved towards some limited fine tuning performed by the Patient. They are also wholeheartedly adopting apps to foster Patient engagement.

Tele-Audiology For Fine tuning

So lets assess both of these concepts separately. First the ability for you to undertake fine tuning remotely. This can be of great help to you in your Practice, particularly if you are under some pressure. But what if you introduced it as a constant in your Practice?

Fine Tuned In The Comfort Of Your Own Home!

All Rehabs Undertaken In Your Own Home Using The Most Modern Of Technology!

I would consider introduction of tele-audiology as an ongoing strategy as damaging to your Patient engagement. Whilst it is an interesting concept for the Patient experience, using it regularly would in fact damage or lower the Patient experience of your brand.

Tele-audiology can be leveraged as a KSP though, but it means that you limit yourself to one manufacturer. The other manufacturers have not moved towards enabling tele-audiology in this manner. So until all of the other manufacturer’s move towards use of this type of technology. It is not something that you may be comfortable using in your hearing healthcare marketing. Fine tuning by tele-audiology is already a possibility, with the rush towards so called iPhone aids, will remote fitting be soon a possibility?

Actually, if we consider the technology as it may work, a more frightening question is raised. Will self fitting soon to be a possibility? Perhaps we should be happy that only one manufacturer has striven for remote fine tuning? Again though as tele-audiology technology moves forward, particularly the external communication technology. More and more manufacturers will realise the ability to both remote fine tune and also remote fit. The question will be whether they enable it.

4 Comments

Glenn, I agree with you on some levels. In fact let me clarify, I agree with you with only one reservation. If remote fitting is commercially enabled, I would be extremely concerned. That would make the technology a threat to the profession, if you can remote fit, so can UHC and their manufacturer friend.

Already doing it, as ReSound gives me an AirLink USB wireless programming transceiver upon request with their top-of-the-line (9xx series) Verso and Alera hearing aids. Here’s how I do it — But *only* with adults who are existing hearing aid users (more in step 4 on this):

• First, I use a fresh install of Aventa 3.4 which installs a clean database in standalone mode. You don’t *have* to perform this step if you don’t mind the patient seeing everyone’s settings (I skip this step for family & close friends);

• Next, based on extensive discussions with the patient, I pre-load four programs based on the audiogram, and configure the Unite accessories using Aventa 3.4 in Standalone mode (Very Important!);

• I then copy the Aventa 3.4 software installer onto a USB memory stick or DVD;

• Since Aventa will be running in standalone mode on the remote PC, I also copy the ReSound folder located in
C:ProgramData as the database is located in
C:ProgramDataResoundAventa3
[NOTE: I actually temporarily rename the Resound folder to hide it from the Aventa installer if I don’t want the patient to see the other patients’ data]

• Next, I deliver the hearing aids to the patient, and configure their PC by installing Aventa 3.4 and copying the
C:ProgramDataResound folder with their database. I also set up a Skype account for them *on their iPad or mobile* (if possible); if not then on their PC using their webcam (Skype works so much better on a mobile or iPad/pod);

• If for some odd reason I can’t use port 3389, I change it to another using RegEdit:
To launch RegEdit: Start –> Run –> regedit.exe then modify this key:
HKEY_LOCAL_MACHINESystemCurrentControlSetControlTerminalServerWinStationsRDP-TcpPortNumberhttp://support.microsoft.com/kb/306759

• Alternately, I load a copy of the RealVNC lite server, and configure it (usually) to work on TCP port 53, and also open up TCP & UDP port 53 in the router firewall.

• I next install Dynamic DNS and assign a host name: Dynamic DNS runs as a background service allowing me to “find” their PC by hostname, instead of having them manually poll the router. More here:http://dyn.com/support/clients/
Alternately, if their router has Dynamic DNS (many do now), then I give it a host name;

• Finally, I test everything out, and then have the initial face-to-face fitting session; and instruct them on how to use the fitting software if they want the “keys to the car.” Generally, I caution them to leave the gain & compression settings alone (I change them in a remote session); however I instruct them on how to pair accessories, and also tweak the noise reduction, mic zooming settings, and mic on/off when the DAI, TV, Phone Clip and Mini Mic accessories are used: This way if they want to add accessories, they can configure it themselves.

Now THIS is how you do Telehealth properly!

FOOTNOTES:
1) My friend who is a deaf audiologist in Toronto got implanted in Germany, and her CI centre gave her the programmer for them to perform remote MAPping.

2) Top CI audiologist Bill Shapiro at NYU Langone in Manhattan also has done this, but with the CI interface box in an audiologist’s office who is there with the patient.

3) There is also talk in the pediatric auditory brainstem implant (ABI) community that Dr Vittorio Colletti’s audiologist in Verona, Italy will be performing remote MAPping, as most of his infants & toddlers are using Med-El ABI’s. Of course, any time you MAP an ABI it has to be closely supervised by a physician with rescussitative gear, in addition to having an audiologist with the patient.

What you are doing is a workaround. It isn’t terribly easy. Whilst I agree that this type o initiative may bring value to your Practice. I am also suspicious that if remote fitting becomes too easy, what does that do to your value as a hearing healthcare professional?